SCLC

Question 1

non-smoker SCLC?

Answer 1

only 2-3% of cases. 98% from smoking. would re-biopsy and re-review if no smoking history

Question 2

IHC markers

Answer 2

CD56, chromogranin, synaptophysin

Question 3

TTF-1 in SCLC

Answer 3

positive in 70-80% cases

Question 4

SCLC molecular

Answer 4

> 90% mutated for p53, Rb; diversity of genetic alterations with chromosomal instability

Question 5

SCLC transformation

Answer 5

acquired resistance to EGFR TKI–> sensitizing mutation Exon 19 is retained but becomes SCLC, tx with EP

Question 6

SCLC clinical

Answer 6

bone pain, SVC, paraneoplastic

Question 7

paraneoplastic

Answer 7

cushing’s (5% of patients), SIADH, hypercalcemia (rare, mediated by PTHrP),

Question 8

low Na at presentation

Answer 8

adverse prognostic factors, Tx chemo, ketoconazole, mitotane, adrenalectomy

Question 9

SIADH in SCLC

Answer 9

10% of SCLC patients, symptoms in only half; Tx chemotherapy, fluid restrict, tolvaptan (oral V2 antagonist)

Question 10

neurologic paraneoplastic

Answer 10

encephalomyelitis (anti-HU), retinopathy, lambart-eaton (ca channel mediated)

Question 11

paraneoplastic

Answer 11

not effective treatments

Question 12

lambert eaton syndrome

Answer 12

5% SCLC; proximal weakness improves with use; hyporeflexia, autonomic dysfcn, Tx IVIG, rituxan, plasmaphoresis

Question 13

staging

Answer 13

30% with limited disease- found within one irradiation portal (can include a supraclav node); 70% extensive stage

Question 14

survival

Answer 14

limited stage: 20mo survival, 20% cure; extensive: 10mo survival, no cure; untreated 2-4mo

Question 15

treatment limited stage

Answer 15

concurrent chemorad better over chemo alone: sequential tx no benefit!

Question 16

concurrent chemoRT

Answer 16

twice daily RT improved OS compared to once daily; standard of care. ongoing study to evaluate 45 v. 60Gy

Question 17

surgery in SCLC

Answer 17

40-70% survival (stage I N0 small tumors, all pts get chemo as well either before or after, need mediastinoscopy; remove entire lobe, if nodal met, give adjuvant chemoRT)

Question 18

standard metastatic

Answer 18

EP: etoposide + cisplatin

Question 19

cis/etop v. carbo/etop

Answer 19

interchangable, both can be given with RT; meta-analysis shows equivalent

Question 20

irinotecan/cis v. etop/cis

Answer 20

both similar survival and PFS and ORR: trade-of GI toxicity for heme toxicity: EQUIVELANT

Question 21

UGT1A1 and irinotecan

Answer 21

makes more toxic

Question 22

brain mets SCLC

Answer 22

18% of pts at presentation, 80% at 2 years, standard of care: 25Gy/10Fx or 30Gy/15Fx, given after systemic therapy, give within 6-8wks, do MRI before;

Question 23

second line treatment

Answer 23

topotecan only (can be oral), OS 6 months von Pawel JCO 1999; improved control of symptoms

Question 24

SCLC epi

Answer 24

13% of lung cancer cases, 10mo OS extensive, 20mo limited stage

Question 25

paraneoplastic syndroms: SIADH with SCLC

Answer 25

from vasopressin or Atrial natureitc cactor

Question 26

SCLC- cushing's

Answer 26

ACTH, late stage of disease, refractory hypoK

Question 27

hypercalcemia for SCLC

Answer 27

rare, from PTHrP, more often in SCC

Question 28

SIADH with SCLC

Answer 28

symptoms in 5% only. Tx- chemotherapy!, can restrict fluid, give salt, demeclocycline-->from a nephrogenic DI that counteracts, tolvaptan (oral)-->have to be careful because pts are sensitive, have to start it in hospital.

Question 29

neurologic paraneoplastic with SCLC

Answer 29

can precede Dx of SCLC for months, not related to tumor bulk, have improved survival! symptoms do not resolve with chemo, little other treatments (irreversible damage)

Question 30

Lambert-Eaton

Answer 30

related to SCLC, ab against voltage-gated channels, get EMG test

Question 31

anti-Hu with SCLC

Answer 31

encephalomyelitis

Question 32

SCLC genetics

Answer 32

90% have mutations against p53 and Rb, 27% have SOX2 amp, 10% PTEN must,

Question 33

SCLC presentation

Answer 33

often BM infiltration, nucleated RBC, neutropenia/thrombocytopenia. get MRI brain/ CT Chest with liver/adrenals

Question 34

Staging of SCLC

Answer 34

limited: tumor confined to radiation port (can include ipsi supraclav LN, but NOT pleural effusion); extensive: not

Question 35

TNM staging SCLC

Answer 35

eh

Question 36

limited stage treatment

Answer 36

cis/etop (4-6) with concurrent RT upfront (45Gy /BID or 63Gy/day)

Question 37

extensive stage treatment

Answer 37

cis/etop x 4 (or carbo)

Question 38

second line SCLC

Answer 38

topotecan or CAV, irinotecan, taxol/doce, gem, vino, temodar

Question 39

SCLC after PR/CR to first line Tx

Answer 39

prophylactic WBRT, monitor with CT scan (if 3yr+, cure 95%)

Question 40

primary refractory SCLC

Answer 40

topotecan or CAV

Question 41

old and fit

Answer 41

still give cis/etop